UncategorizedDerek Ross, Medical Training leader for Territorial Defense Forces Mobile Training Team and former US Army Special Forces Medical Sergeant shares insights during Modern Warfare lessons learned and Tech Expo from Ukraine, April 5, 2024, Kyiv Ukraine.

2024-05-01by Sun Tzu0

I appreciate the opportunity to speak here and I’ve come to the country of Ukraine and work with some of your medical personnel. I’ve gotten to work with Territorial Defense Forces and do training, do medical training and help upskill the medics that will be rotating out to the Front.

And today I’m going to share some lessons learned as I’ve talked to fellow Ukrainian brothers and sisters as I’ve gotten to travel around the country and see different hospitals talk to different medical personnel at different levels of care and see how we can improve the outcomes of patients who are getting injured on the battlefield.

And how we can partner as the US to provide some of that training and the experiences that we learned in Iraq and other parts of the world during the GWOT as we built amazing evacuation routes and amazing evacuation procedures that allowed us to live higher quality lives as we came back from injuries.

So some of the things that we’ve been training on is basic T-CCC, bringing it back to the basics doing a lot of repetitions on trauma lanes, ensuring that we’re doing the right thing with the torniquets, ensuring that we’re managing massive hemorrhage. Ensuring that we’re thinking about airway management throughout the patient life cycle. Ensuring that we’re taking care of post injury care, so talking about pain management, talking about antibiotics, talking about how we’re going to evacuate the patient. And to Perrys point and Mike’s point  as they’re talking about the drones on the battlefield, it changes the way that that people operate, changes the type of injuries they’re gonna see, and it changes the confidence in which they can fight with.

One of the things that Perry and I were talking about during the break is we as American forces when we go and we had a target or we go and we do an operation, especially in your first few years before you’ve seen a ton you’re fighting feeling like you’re invincible and you have absolute confidence that one you’re gonna be supported that you’ve got air supported, that you’ve got medical support, that if you do get hurt when you come home, you’re gonna be taking care of, you’re gonna be given opportunities. You’re gonna be, you’re gonna get help with the prosthetic if you need it. You’re going to get help with requalifying for a career if you need it.

And some of those mechanisms are not in place. The tip of the spear within the US military is a very tiny entity within the military compared to the rest of the apparatus. And so much support goes into making sure that we’re confident and so how can we build out those support mechanisms that so that people at the front are fighting and treating patients with confidence.

So some of the things that I saw here that we can learn about is material.

So we talked a little bit about tourniquets and the tourniquets that they have available to them and some of these IFAKs I saw we’re still working with Chinese tourniquets that are breaking as they turn them and so. And a lot of the bleeds are preventable that are happening and patients are dying.

I was at a hospital and I was talking to some of the medics that are frontline medics there and one of the brigades. And as I was talking to her and the patients that she had treated, she had almost was holding back tears in her eyes because she knew that she could have saved some of these patients that she was working with and they’re dying because of lack of equipment. And lack of proper equipment.

The evacuation routes that they’re facing, they cannot do. They cannot take evacuations during the day.

I met a medic and one of the brigades that took mine to both legs and had injuries and walked six kilometers out on his own because he did not have the ability to get to a vehicle. They started in a vehicle but were not able to navigate safe routes and safe terrain. And so they had to get out of the vehicle and move and with the non ambulatory patient, it’s just not possible.

So medics are sitting on patients for up to 72 hours without the type of care and without the type of advanced medical training that an 18 Delta (Special Forces Medical Sergeant) may have in order to do that.

Outside of what I saw as far as battlefield tactics and the need to upscale and upgrade equipment, I saw reintegration of medical experiences and lessons learned into an instructor core. Or even reintegration and remedial training coming back from the line.

So as you’re having these injuries and you’re having these lessons learned specifically on this tourniquet use case, there’s no time or effort to be put into training on these basics and getting those medical assessments down to where they’re becoming second nature.

I even really felt it in myself as I was teaching some of the medics and I was preparing to come out here and do this training how deeply ingrained the basics of T triple C, are in me because of the repetition that I had during my military career, and they’re just not getting the reps in before they go to the front to have that kind of second nature assessment.

We need to be able to upscale the level of care that people are able to do at the frontline. The mandate, at least when I was in as an 18D was 72 hours to take care of patients and what do we need to do that? We needed to be able to do basic surgical. We need to be able to do analgesic administration. We need to be able to do antibiotic administration and do wound care on site.

The medics don’t have the practitioners that are available to do that. They don’t have the medical oversight and that pipeline hasn’t been created to create that training.

So we as NGO’s, in addition to NATO forces, can definitely provide those training sites and we can get creative and where we do that training in order to create a pipeline of skill sets that are coming back to the front.

One of the things that amazed me when I was in Afghanistan was the ability to cooperate with the other services, with civilian entities. I worked at a forward surgical clinic for surgical team for a short time where we had Army surgeons, Air Force surgeons, Navy surgeons.

The organizational situation here is not allowing for that. You have very siloed medical pipelines of oversight. So you may have a surgeon for one brigade that is overseeing material transportation and logistics for one brigade and also overseeing the different levels of care whether it be frontline medics, whether it be nurses.

And they’re very siloed to where they cannot work with other hospitals in a free flowing way. They can’t share information, they can’t share material, they can’t share personnel in a way that allows them to aggregate resources based on what’s happening in the battlefield, based on the amount of patients that they may have.

And so bringing our skill sets and how we built out evacuations for the GWOT even in countries that weren’t necessarily part of the Afghanistan or Iraq fight would bring higher level of care and better outcomes to the patient.

Post Military Care talking about my friend Oleg here and talking to other veterans that have come out

Would bring a higher level of care and better outcomes to the patient. Pause. Talking to other veterans that have come out. Their physical health, having access to physical health care like we do at the VA, having the ability to go outside the civilian clinics and set up as many different pathways as necessary to ensure that veterans have the confidence that if they do get hurt, they’re gonna have post injury care. For the rest of their life, for as long as they’re gonna need it. Knowing that they’re gonna have difficulties before they, before they even get injured, changes their ability to be confident on the battlefield.

Mental Health. We had lots of conversations with the soldiers that we’re working with. Mental health and what they have access to.

We talked a little bit about helping, helping veterans with programs, small business programs. One of the things I had issues with even in the American military was knowing how to navigate the vast majority of programs that are available to us.

Organizations like the DAV, the VFW, we have representatives there that are experts in the system that help us as veterans when we get out and are transitioning, navigate those systems.

I have not come across those organizations, at least at scale, that are helping Ukrainian veterans navigate the availability of services that are out there for them either to reclassify jobs or to get health care.

And for the mental health opportunities, the US VA is exploring all kinds of different holistic and non traditional means of taking care of mental health.

So we’ve got programs that are looking at experimental drugs, specifically MDMA.

We have programs that are hooking up veterans with outdoor hobbyists with Sailing  programs, whatever hobbies that they may get into. Art programs to teach them how to deal with their problems in ways that are more healthy than a lot of the ways that we veterans deal with our issues once we get out.

Education and opportunities so again the GI Bill absolutely changed the outcome of my mental health and my ability to navigate civilian life after I got out.

So giving reclassification opportunities given educational opportunities, opportunities to come back to the military and share lessons learned and that provide that higher purpose to the war is a great opportunity to help out people who are coming off the line.

Some of the more dire needs that I saw as I was out there closer to the front was lack of vehicles, so lack of crude vehicles especially.

Vehicles will sometimes get out to the front and they’re not being used in a way that that’s sufficient and they’re quickly being taken off the line, disabled by drones, being disabled by artillery, so providing holistic solutions that are provide a vehicle, and provide a crew, provide training and help get creative with the way to get patients back to those units as fast as possible and bring higher levels of patient care as close to the front as possible.

All of this has been quite overwhelming amount of information and quite overwhelming reality to see, to be able to talk to frontline medics, to be able to talk to frontline tacticians and warfighters.

One of the things I would love to see is creating a lower barrier to entry for other veterans like myself to be able to get here. I think we as a Green Berets are used to navigating extremely difficult obstacles to get where we need to go, but there is a large amount of experienced veterans from the GWOT that if we gave them a way to get here, and lower that barrier to entry, brought them maybe to somewhere closer, like Lviv or Poland. We could definitely create training pipelines and bring that experience closer to the Ukrainians so we could pass those lessons learned, partner together, and bring up that level of care across the entire fighting force. So those are some of the things I saw, and I appreciate you having time any questions that I can answer about what I saw.


Chicago. Growing up walking the streets in Chicago, Ukraine is relatively safe, so it is not an environment that you cannot exist in. Lots of restaurants. I got to see the opera while I was here, so it’s a very permissive environment and very friendly environment. I’ve had a great time not only working with the with the TDF here, but just mainly been making friends with local Ukrainian so. Please come out and test your products. Please provide them if there’s any way that we can help, we will do so.

The Siren just now gave me a thought. There are sirens everywhere in Ukraine from the time you get in. From the West all the way to the East, the siren is an ever present sound. It’s an ever present sound and culture.

And I hope that what you take today, you, especially the Americans on the phone call and the people who don’t live in Ukraine on the phone call, you take the stories that you’ve heard and you talk about Ukraine with the people that you know with your families when you’re sitting at a dinner table. Because everything I heard about Ukraine from the news and from whatever you know whatever is trickling down through social media was absolutely not nuanced and absolutely not a real the reality of the story that’s happening here in Ukraine. So I hope you tell the stories back home and you talk about what you’ve heard and you share that and push people to.

To get involved because when I was on the train heading out the to the East and coming back, it hit me how when I flew to war, I flew across a sea to fight in an arena that was nowhere near my family and when I was going out the soldiers were very quiet. And when I was coming back, they were very loud and chatty, excited to come home. And we’re talking kilometers from their home. They’re fighting these battles. So I hope you talk about it. I hope you inspire people at home to get involved.

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